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Post Operative Care of Achilles Tendon Repair:

- Discussion:
           - posterior splint for 10 days in maximum equinus to reduce tension on the incision;
           - cam walker w/ 15 deg of equinus (or gravity equinus), non wt bearing;
           - pts are permitted non wt bearing ankle ROM exercises out of the cam walker;
           - after approximately 3-4 weeks the leg is brought out of equinus to a neutral positoin;
           - gradual wt bearing is allowed at 6 weeks;
           - consider DVT prophylaxis for 6 weeks;
           - Murphy's law:
                 - tell patients to be careful with shoe wear for the first 6 months post op, since the shoe counter (heel) can rub and abrade the incision (leading to secondary wound breakdown); 

           - in the report by Speck M, et al (1998), the authors report on their experience with early full wt bearing;
                 - evaluated the clinical outcomes of 20 pts w/ early full wt bearing and functional treatment after surgical repair of  acute Achilles tendon rupture;
                 - patients underwent open repair using a Kessler-type suture and simple apposition sutures;
                 - postoperative regimen included a plantigrade splint for 24 hours and 6 weeks of early full wt bearing in a removable walker;
                 - at 1 day after surgery, early full wt bearing alternating with passive range of motion exercises was initiated;
                 - patients were instructed to move the ankle four times a day between 20° of plantar flexion and 10° of extension;
                 - there were no reruptures
                 - Early full weightbearing and functional treatment after surgical repair of acute achilles tendon rupture.

- references:
       - Immobilization in neutral versus equinus position after Achilles tendon repair. A review of 32 patients.
       - Early motion of the ankle after operative treatment of a rupture of the Achilles tendon. A prospective, randomized clinical and radiographic study.
       - Elongation of the Achilles Tendon After Rupture Repair Occurred Slightly Less with Postoperative Early Motion Than with Postoperative Immobilization.
       - Early Motion for Achilles Tendon Ruptures: Is Surgery Important? A Randomized, Prospective Study
       - The Influence of Early Weight-Bearing Compared with Non-Weight-Bearing After Surgical Repair of the Achilles Tendon
       - AAOS issues acute Achilles tendon rupture guidelines
       - Effect of knee position on gap size following acute Achilles rupture